Balloon Pulmonary Angioplasty

Overview

When conventional medical treatments are ineffective, sometimes doctors may turn to advanced surgical procedures to acquire desired treatment outcomes. Chronic thromboembolic pulmonary hypertension (CTEPH) affects about 2–4% of patients who have experienced blood clots in the lungs (pulmonary embolism). The standard treatment for CTEPH is pulmonary endarterectomy, a surgical procedure to remove the clots. However, not all patients are candidates for surgery, and in some cases, the operation may not fully clear the blockages within the pulmonary arteries. That’s when balloon pulmonary angioplasty (BPA) is used as an alternative treatment.

Reasons for undergoing the procedure

A form of Pulmonary hypertension, known as chronic thromboembolic pulmonary hypertension (CTEPH), is a rare but serious condition that arises when blood clots in the lungs (pulmonary emboli) do not dissolve as they should. Over time, these clots cause scarring and narrowing in the pulmonary arteries, which increases blood pressure in the lungs, placing stress on the right side of the heart. In severe cases, this causes progressive difficulty in breathing, limits physical activity, and decreases overall life expectancy. For patients with CTEPH who are not suitable for surgery, balloon pulmonary angioplasty (BPA) is a well-recognized intervention designed to address these vascular obstructions. The procedure has been shown to reduce pulmonary artery pressure, enhance breathing capacity, and improve exercise performance in appropriately selected patients.

The benefits of Balloon Pulmonary Angioplasty are that it can greatly improve shortness of breath, decrease pressure within the pulmonary arteries, and lessen the strain on the heart. These benefits tend to be long-lasting, often extending over several years. However, most patients will still require ongoing treatment to manage any remaining pulmonary hypertension.

Risks

Balloon Pulmonary Angioplasty (BPA) is generally safe, but like any procedure, it carries some risks. The chance of serious complications like death, major bleeding, or needing emergency heart or lung support is very low—less than 1 in 100 people. About 1 in 10 patients may temporarily feel more breathless or cough up blood or fluid. This is called reperfusion injury, which happens when blood suddenly returns to lung areas with poor circulation. It usually gets better within 1 to 2 days and is often treated with oxygen and medications. In rare cases, stronger breathing support or even a ventilator may be needed.

Before the procedure

Before Balloon Pulmonary Angioplasty (BPA), patients typically undergo several preparations:

1. Medication Review: Certain medications, especially blood thinners, may need to be temporarily stopped.
2. Fasting: Patients usually need to fast for several hours prior to the surgery.
3. Detailed Evaluation: Imaging (angiography) and right heart catheterization are performed to map out blockages and measure pressures.
4. Sedation Planning: BPA is done under sedation, so preparations are made for monitoring and managing.
5. Vascular Access: The insertion site (groin) is prepped for catheter insertion.

During the procedure

Balloon Pulmonary Angioplasty is done under mild sedation. The procedure involves inserting a small catheter into a vein in the groin, a larger hollow tube is then guided into the blood vessels of the lungs. To locate the narrowed or blocked vessels, a contrast dye containing iodine is injected into each vessel while X-ray images are taken for visualization.

Next, an ultra-thin wire is passed through the targeted vessels, and a small balloon is inserted along the wire to the affected area. The balloon is briefly inflated for a few seconds to compress the blockage and restore blood flow to that portion of the lung. It is then deflated and withdrawn. This process may be repeated several times in different vessels during one procedure.

After the procedure

Following the procedure, you may feel drowsy and have little or no memory of what happened during the treatment. You will be taken back to the ICU/ward, where the nurse will continue to monitor the site in your groin. It’s essential to limit movement for about two hours afterward to minimize the risk of bleeding at the insertion site. You will need to remain in bed during this time, spending the first hour lying flat. Then, you will be assisted to sit up and gradually begin moving around.

The nurse will check your vital signs more frequently, and a chest X-ray will be performed. Your breathing will be closely observed, and some patients may need supplemental oxygen for the first few hours. Once the procedure is complete, you will be offered some food and drinks. You may also be encouraged to drink plenty of fluids to help remove the contrast dye from your system. Your doctor will recommend accordingly. Blood-thinning medications will be restarted a few hours after the treatment.

Bruising around the groin and upper leg is a common after-effect of the procedure and may occasionally extend toward the abdomen. To ensure proper healing of the groin, it is important to follow a few care guidelines. Refrain from driving for 48 hours after the procedure and apply gentle pressure to the area when climbing stairs, coughing, or sneezing during this time. Avoid heavy lifting or any excessive physical activity for at least 48 hours. If bleeding occurs at the groin site, do not panic—lie down flat and have someone apply pressure to the area for 10 to 15 minutes. Once the bleeding stops, seek medical attention. The wound will be covered with a small bandage. and should be removed the day after the procedure. You may shower or bathe the following day but avoid using talcum powder near the site until it has completely healed.

Outcome

After Balloon Pulmonary Angioplasty (BPA), most people feel better within a few days or weeks. You may notice it’s easier to breathe, you have more energy, and you can do more physical activities without getting tired. The pressure in your lungs should improve, which helps reduce the strain on your heart. Some patients may need more than one BPA session to treat all the affected areas. Even after the procedure, you may still need to take medications such as blood thinners or drugs for lung pressure. Your doctor will schedule a follow-up visit within 1 to 2 weeks to check on your recovery and may do tests like a chest X-ray, breathing tests, or a walking test. Based on how you’re doing, your doctor might adjust your medications or plan another BPA session. Regular check-ups will be important to make sure you continue to improve.